Talking With Terminally Ill Patients and Their Caregivers About Death, Dying, and Bereavement (original) (raw)
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Journal of social work in end-of-life & palliative care, 2014
Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the "Final Conversations Scale" was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality/religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness/death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale.
Creating the Final Conversations Scale: A Measure of End-of-Life Relational Communication
Final conversations (FCs) are defined as the communicative interactions, both verbal and nonverbal, that occur between terminally ill patients and relational partners. In this study, the ''Final Conversations Scale'' was developed and tested. A total of 152 participants that had engaged in final conversations with individuals that were terminally ill completed the newly developed instrument. Factor analysis produced a five-factor structure, including: messages of spirituality=religion; expressions of love; proactive difficult relationship talk; everyday communication; and talk about illness=death. Participants' perceptions of the relational closeness and difficulty with the deceased significantly influenced the individuals' recalled frequency of FCs messages. Practical and scholarly implications focus on the needs of the family members regarding their communication with terminally ill individuals, as well as directions for future research with the FCs Scale.
Journal of Pain and Symptom Management, 2005
The aim of this study was to explore by whom, how, and when discussions about prognosis and end-of-life issues should be initiated with terminally ill patients, and the context in which these issues can be optimally discussed. Focus groups and individual interviews were conducted with 19 palliative care (PC) patients, 24 carers, and 22 PC health professionals (HPs). Participants had disparate views regarding by whom and when such discussions should be initiated, although a similar range of perspectives was expressed by all participant groups. Four main approaches were identified: wait for the patient/carer to raise the topic; HPs to offer all PC patients and their carers the opportunity to discuss the future (preferred by the majority of participants); HPs to initiate the discussion when the patient/family need to know; or HPs to initiate the discussion when the patient/family seem ready. Four themes emerged regarding the optimal context of the discussion: importance of the relationship with HP, clarifying the patient/carers' understanding and how much detail they want to know, negotiating who should be present during the discussion, and who should deliver the information. Initiating prognostic discussions with terminally ill patients requires considerable skill and sensitivity. Communication skills training for HPs may be required to optimize such discussions. J Pain Symptom Manage 2005;30:132-144. Ć 2005 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Patient Education and Counseling, 2015
Objective-Clinician discomfort with death may affect care of patients but has not been wellstudied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them. Methods-Qualitative interviews with physicians (n = 25), nurse practitioners (n = 7), and physician assistants (n = 1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality. Results-Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients. Conclusion-An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care. Practice implications-Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients.
Increasing Comfort With End-of-Life Discussions
2015
End-of-life discussions and advanced care planning are part of the healthcare process, and within the scope of practice for providers. Despite the evidence supporting the effectiveness of these conversations, the system falls short. Talking about death is never easy. At times, it is difficult for healthcare providers to approach the topic with patients who are living with serious life-limiting illness. Reports in the end-of-life literature reveal that healthcare professionals avoid discussions about preparations for end-of-life care due to feeling unprepared, and a lack of framework for such discussions. Purpose: The purpose of this doctoral project was to improve the quality of end-of-life care for patients with life-limiting illnesses by increasing provider comfort with end-of-life conversations. Method: This project was a Quazi-experimental pre and post intervention design. A preintervention baseline assessment of healthcare providers comfort with end-of-life discussions through a self-assessment survey and retrospective chart audits was conducted. An educational intervention was completed implementing an evidenced-based tool to guide end-of-life discussions. Healthcare providers were instructed to utilize the tool for sixty days to guide them in end-of-life discussions on appropriate patients. Post intervention data was collected to include a repeat of the self-assessment survey and retrospective chart audits to determine changes in comfort level. Conclusion: Providers reported increases in level of comfort and demonstrated an increase in conversations from baseline.
Discussing Palliative Care with Patients
Annals of Internal Medicine, 1999
Palliative care focuses on relief of suffering, psychosocial support, and closure near the end of life. Even experienced physicians often struggle when initiating complex, emotionally laden discussions about palliative care with seriously ill patients and their families. We use two hypothetical case scenarios to illustrate how physicians can initiate these discussions and to emphasize and illustrate several communication techniques. Physicians can elicit a patient's concerns, goals, and values by using open-ended questions and following up on the patient's response before discussing specific clinical decisions. Physicians can acknowledge patients' emotions, explore the meaning of these emotions, and encourage patients to say more about difficult topics. Physicians should also screen for unaddressed spiritual and existential concerns. Some patients may make statements or ask questions that are difficult for physicians to respond to. We provide examples of responses that align the physician with patients' wishes without reinforcing unrealistic plans. Exploring such difficult issues may lessen feelings of aloneness even when the physician cannot "fix" the problem, and it raises new opportunities for patients to find comfort. In addition to addressing physical suffering, physicians can extend their caring by acknowledging and exploring psychosocial, existential, or spiritual suffering. As patients struggle to find closure in their lives, active listening and empathy have therapeutic value in and of themselves.